Quality Specialist III

Premera Blue Cross

3d•Remote

About The Position

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. Are you passionate about driving quality and making a meaningful difference in the lives of members? As a Quality Specialist III, you will play a pivotal role in ensuring every member experience meets the highest standards of excellence. Your expertise will directly impact member satisfaction and trust by safeguarding compliance, supporting audit processes, and fostering a culture of continuous improvement—helping us deliver care and service our members can rely on, every step of the way. The Quality Specialist III is responsible for conducting and overseeing Premera’s compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Local Operations Scorecard (LOS) and Licensee Desk Level Audit (LDLA), the Federal Employee Program (FEP) audit and tier II support to customer service representatives and QA teams, both offshore and onshore, along with ensuring compliance with state and federal laws, contracts and the achievement of corporate objectives. The Quality Specialist III has the ability to audit a wide variety of audits and is considered a technical expert. In addition to conducting complex audits, the Quality Specialist III is also responsible for hands-on training to assist auditors on auditing techniques and practices. The Quality Specialist III ensures the Quality Review & Reporting (QRR) team has the necessary tools, processes, procedures and training needed to support the end-to-end audit process. They evaluate business needs, legal/compliance documents and lead calibration meetings. They will also guide/recommend training on new or modified auditing methods or systems, analyze system and process enhancement requests, evaluate quality and compliance within the department, and recommend appropriate employee development and training opportunities. The Quality Specialist III acts in a consulting capacity with other departments to identify opportunities for improvement throughout the company and assist in the coordination of project based as well as external customer audits.

Requirements

Four (4) years of customer service, claims or membership and billing experience in a call center, healthcare, or insurance environment (Required).
Two (2) years of experience in training or audit functions (Required).
Experience with operational procedures (Required).
Completion of internal or external courses dealing with facilitation skills, conflict management, dealing with difficult people, etc.
Bachelor’s Degree or four years related experience.

Nice To Haves

Quality certification such as Certified Quality Auditor (CQA), Quality Improvement Associate (CQIA), Quality Process Analyst Certification (CQPA).

Responsibilities

Lead and organize training for all Quality Specialists on audit processes, procedures, and tools.
Conduct complex audits and verifying quality standards for selected inquiries and make decisions whether discrepant information meets BCBSA and FEP audit requirements, state, and federal mandates.
Provide second-level support on escalated issues and audit findings.
Collaborate with team members, OCLD, and management to identify training gaps and business needs and implement actions while partnering to address these issues.
Review, evaluate, and provide feedback on trainees’ audits and learning processes.
Act as a consultant with external departments to help resolve high-impact business issues by recommending action plans related to quality assurance.
Assist the Data Reporting Analyst in collecting data and providing analyses for various issues across the department and other functional areas.
Foster a training and auditing culture that values diversity of thought, leveraging team member strengths to achieve team goals.
Assist with external audits and lead special projects.
Perform other duties as assigned.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
Generous paid time off to reenergize.
Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.